X-ray
Osteomyelitis can be made visible by imaging techniques. However, in acute osteomyelitis, the changes in the bone structure are only visible on X-rays after about one to two weeks. In the further course of the disease, the x-ray reveals spotty brightening, detachment of the periosteum from the bone and calcifications (ossifications).
In chronic osteomyelitis, parts of the bone often die off, leaving behind a residual body (sequester), and new bone tissue forms in the vicinity of these bone parts. The resulting connective tissue around the residual body is visible in the X-ray image as a bright seam. If osteomyelitis is diagnosed at a very early stage, conservative therapy with targeted antibiotic therapy and immobilization is possible.
A smear is taken from the spot of the focus and the pathogen causing the disease is determined. Then a specific antibiotic therapy is administered until the inflammation parameters in the blood count normalize. In addition, adequate pain therapy (analgesia) must be ensured.
Often, however, it is necessary to carry out a quick surgical intervention to clean up the focus. In this case, the bone is drilled to relieve pressure (bone trepanation), thoroughly rinsed and the damaged bone areas removed. Antibiotic carriers are often inserted in order to achieve locally high levels of antibiotic action.
Depending on the extent of the defect in the bone, bone transplants and several follow-up operations may have to be performed. Only through immediate therapy can healing of osteomyelitis be achieved without bone or joint damage. Often the therapy of osteomyelitis is a long process.
A distinction must be made between endogenous hematogenic osteomyelitis in infants, children and adults. The therapeutic treatment of osteomyelitis in infancy is carried out by the administration of penicillins according to the pathogen spectrum and by immobilising the affected body region with a splint or plaster cast. If a joint is affected by osteomyelitis, this joint is usually rinsed.This can work in several ways: In case osteomyelitis has progressed so far that the growth plate has already been damaged, secondary reconstructive measures may become necessary.
The therapeutic treatment of osteomyelitis in childhood is carried out by targeted antibiotic administration in combination with immobilization by means of a splint or plaster cast of the corresponding body region. In very special cases, for example when residual bodies or abscesses are formed, surgical intervention may become necessary. Only in rare cases does a transition from the acute to the chronic form of osteomyelitis occur.
Therapy in adulthood is also carried out by means of targeted antibiotic administration in conjunction with immobilization by means of a splint or plaster cast. In contrast to infancy or childhood, the bacterial foci of osteomyelitis are cleared early in adulthood. In this process, any bone parts that may have been removed must be replaced by so-called cancellous bone grafting (= transplantation of bone substance from another, autologous, healthy bone) in order to maintain the functionality of the corresponding extremity.
In addition, in the case of tehrapie, irrigation – suction – drains are inserted to flush foci out of the affected joints. In contrast to acute osteomyelitis in children, recurrence and transition to the chronic form of osteomyelitis often occurs in adults.
- By puncture or
- Through a so-called flush – suction – drainage.
As already mentioned, in infancy and childhood there is a risk that the acute inflammation will cause damage to the growth zone (= metaphysis) of the affected bone.
Under certain circumstances, this damage can then cause severe deformities or shortening of the affected extremities. There is a particular risk of osteomyeltitis up to the age of 2 years. At this age, the blood vessels of the medullary canal run directly from the metaphysis (= growth zone of the bone) through the cartilaginous epiphysis joint into the pineal gland (= end piece of the bone; transition to the joint).
As a result, the pathogens can also penetrate into the joints and cause purulent joint effusions there, which in turn can cause severe joint damage and possibly even growth disorders. Every acute endogenous hematogenic osteomyelitis, especially in adult patients, carries the risk of developing the chronic form. In this case, considerable remodelling processes take place within the affected bone.
Under certain circumstances, bone infarctions can occur, as a result of which certain parts of the bone are no longer supplied with blood and die. The dead bone parts then remain as residual bodies (= sequester) in the infected area. In addition, reactive connective tissue formation (= osteosclerosis) occurs, which reduces the elasticity of the bone and increases the risk of bone fractures. Adults in particular tend to form recurrences.
